Purpose NRG Oncology/RTOG 1203 was designed to compare patient-reported acute toxicity and health-related quality of life during treatment with standard pelvic radiation or intensity-modulated ...radiation therapy (IMRT) in women with cervical and endometrial cancer. Methods Patients were randomly assigned to standard four-field radiation therapy (RT) or IMRT radiation treatment. The primary end point was change in patient-reported acute GI toxicity from baseline to the end of RT, measured with the bowel domain of the Expanded Prostate Cancer Index Composite (EPIC). Secondary end points included change in patient-reported urinary toxicity, change in GI toxicity measured with the Patient-Reported Outcome Common Terminology Criteria for Adverse Events, and quality of life measured with the Trial Outcome Index. Results From 2012 to 2015, 289 patients were enrolled, of whom 278 were eligible. Between baseline and end of RT, the mean EPIC bowel score declined 23.6 points in the standard RT group and 18.6 points in the IMRT group ( P = .048), the mean EPIC urinary score declined 10.4 points in the standard RT group and 5.6 points in the IMRT group ( P = .03), and the mean Trial Outcome Index score declined 12.8 points in the standard RT group and 8.8 points in the IMRT group ( P = .06). At the end of RT, 51.9% of women who received standard RT and 33.7% who received IMRT reported frequent or almost constant diarrhea ( P = .01), and more patients who received standard RT were taking antidiarrheal medications four or more times daily (20.4% v 7.8%; P = .04). Conclusion Pelvic IMRT was associated with significantly less GI and urinary toxicity than standard RT from the patient's perspective.
Although rare, interstitial ectopic pregnancy poses a challenge in diagnosis and management. The pregnancy is implanted in the interstitial part of the fallopian tube, i.e., the proximal intramural ...portion. When ruptured, it results in a catastrophic event; the rupture can involve the uterine wall, as in this case, which puts the prognosis of future pregnancies at risk. Here, a case of a 35-year-old primigravida who conceived after ovulation induction is reported. Her diagnosis of ectopic pregnancy was missed; it was misdiagnosed as incomplete abortion followed by dilatation and evacuation. Post-evacuation severe pain and hemodynamic instability, and subsequent ultrasonography (USG) lead to the diagnosis of left interstitial ectopic pregnancy. Emergency laparotomy, left salpingo-oophorectomy, and cornual resection with repair were done.
Peripartum cardiomyopathy (PPCM) is a rare disorder that generally affects the elderly multigravida females. It is a type of dilated cardiomyopathy that generally affects the last trimester of ...pregnancy or early postpartum period. Several risk factors are associated with the development of PPCM. Even though PPCM has greater morbidity, if managed promptly, it can be reverted with minimal morbidity or mortality. We present a case of a young woman, multigravida, with moderate anemia corrected, who was taken for emergency lower segment cesarean section, without previous cardiac evaluation, and ended up with pulmonary edema intraoperatively. Later on, her evaluation was done which came out to be PPCM. She was managed conservatively thereafter with no significant morbidity and a good maternal and perinatal outcome. We should be alert in diagnosing a case of PPCM with prompt treatment to reduce mortality. Cardiovascular conditions cause approximately 26 percent of pregnancy-related deaths which include valvular heart disease and congenital heart disease. Appropriate diagnosis and management are necessary for preventing mishaps.
This report presents the analysis of the RTOG 0537 multicenter randomized study that compared acupuncture-like transcutaneous stimulation (ALTENS) with pilocarpine (PC) for relieving ...radiation-induced xerostomia.
Eligible patients were randomized to twice-weekly 20-minute ALTENS sessions for 24 sessions during 12 weeks or PC (5 mg 3 times daily for 12 weeks). The primary endpoint was the change in the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS) scores from baseline to 9 months from randomization (MFR). Secondary endpoints included basal and citric acid primed whole salivary production (WSP), ratios of positive responders (defined as patients with ≥20% reduction in overall radiation-induced xerostomia symptom burden), and the presence of adverse events based on the Common Terminology Criteria for Adverse Events version 3. An intention-to-treat analysis was conducted.
One hundred forty-eight patients were randomized. Only 96 patients completed the required XeQOLS and were evaluable at 9 MFR (representing merely 68.6% statistical power). Seventy-six patients were evaluable at 15 MFR. The median change in the overall XeQOLS in ALTENS and PC groups at 9 and 15 MFR were -0.53 and -0.27 (P=.45) and -0.6 and -0.47 (P=.21). The corresponding percentages of positive responders were 81% and 72% (P=.34) and 83% and 63% (P=.04). Changes in WSP were not significantly different between the groups. Grade 3 or less adverse events, mostly consisting of grade 1, developed in 20.8% of patients in the ALTENS group and in 61.6% of the PC group.
The observed effect size was smaller than hypothesized, and statistical power was limited because only 96 of the recruited 148 patients were evaluable. The primary endpoint-the change in radiation-induced xerostomia symptom burden at 9 MFR-was not significantly different between the ALTENS and PC groups. There was significantly less toxicity in patients receiving ALTENS.
Radiation dose to the neuroregenerative zone of the hippocampus has been found to be associated with cognitive toxicity. Hippocampal avoidance (HA) using intensity-modulated radiotherapy during ...whole-brain radiotherapy (WBRT) is hypothesized to preserve cognition.
This phase III trial enrolled adult patients with brain metastases to HA-WBRT plus memantine or WBRT plus memantine. The primary end point was time to cognitive function failure, defined as decline using the reliable change index on at least one of the cognitive tests. Secondary end points included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported symptom burden.
Between July 2015 and March 2018, 518 patients were randomly assigned. Median follow-up for alive patients was 7.9 months. Risk of cognitive failure was significantly lower after HA-WBRT plus memantine versus WBRT plus memantine (adjusted hazard ratio, 0.74; 95% CI, 0.58 to 0.95;
= .02). This difference was attributable to less deterioration in executive function at 4 months (23.3%
40.4%;
= .01) and learning and memory at 6 months (11.5%
24.7%
= .049 and 16.4%
33.3%
= .02, respectively). Treatment arms did not differ significantly in OS, intracranial PFS, or toxicity. At 6 months, using all data, patients who received HA-WBRT plus memantine reported less fatigue (
= .04), less difficulty with remembering things (
= .01), and less difficulty with speaking (
= .049) and using imputed data, less interference of neurologic symptoms in daily activities (
= .008) and fewer cognitive symptoms (
= .01).
HA-WBRT plus memantine better preserves cognitive function and patient-reported symptoms, with no difference in intracranial PFS and OS, and should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases with no metastases in the HA region.
In oncology trials, the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) is the standard tool for reporting adverse events (AEs), but it may underreport symptoms ...experienced by patients. This analysis of the NRG Oncology RTOG 1203 compared symptom reporting by patients and clinicians during radiotherapy (RT).
Patients with cervical or endometrial cancer requiring postoperative RT were randomly assigned to standard 4-field RT or intensity-modulated RT (IMRT). Patients completed the 6-item patient-reported outcomes version of the CTCAE (PRO-CTCAE) for GI toxicity assessing abdominal pain, diarrhea, and fecal incontinence at various time points. Patients reported symptoms on a 5-point scale. Clinicians recorded these AEs as CTCAE grades 1 to 5. Clinician- and patient-reported AEs were compared using McNemar's test for rates > 0%.
Of 278 eligible patients, 234 consented and completed the PRO-CTCAE. Patients reported high-grade abdominal pain 19.1% (
< .0001), high-grade diarrhea 38.5% (
< .0001), and fecal incontinence 6.8% more frequently than clinicians. Similar effects were seen between grade ≥ 1 CTCAE toxicity and any-grade patient-reported toxicity. Between-arm comparison of patient-reported high-grade AEs revealed that at 5 weeks of RT, patients who received IMRT experienced fewer GI AEs than patients who received 4-field pelvic RT with regard to frequency of diarrhea (18.2% difference;
= .01), frequency of fecal incontinence (8.2% difference;
= .01), and interference of fecal incontinence (8.5% difference;
= .04).
Patient-reported AEs showed a reduction in symptoms with IMRT compared with standard RT, whereas clinician-reported AEs revealed no difference. Clinicians also underreported symptomatic GI AEs compared with patients. This suggests that patient-reported symptomatic AEs are important to assess in this disease setting.
Internet of Things (IoT) is a network spread globally and accommodates maximum things under it. All these things are connected globally using IPv6 protocol which satisfies the need of connecting ...maximum devices by supporting 2^128 addresses. Because of heavy-weight nature of IPv6 protocol, a compressed version of it known as IPv6 Low Power Personal Area Network (6LoWPAN) protocol is used for a resource-constrained network that communicates over low power and lossy links. In IoT, devices are resource-constrained in terms of low battery power, less processing power, less transceiver power, etc. Also these devices are directly connected to insecure internet hence it is very challenging to maintain security in IoT network. In this paper, we have discussed various attacks on 6LoWPAN and RPL network along with countermeasures to reduce the attacks. DoS attack is one of the severe attacks in IoT which has various patterns of execution. Out of various attacks we have designed Intrusion Detection System (IDS) for Denial of Service (DOS) attack detection using Contiki OS and Cooja simulator.
Initial report of NRG Oncology CC001, a phase 3 trial of whole-brain radiation therapy plus memantine (WBRT + memantine) with or without hippocampal avoidance (HA), demonstrated neuroprotective ...effects of HA with a median follow-up of fewer than 8 months. Herein, we report the final results with complete cognition, patient-reported outcomes, and longer-term follow-up exceeding 1 year.
Adult patients with brain metastases were randomized to HA-WBRT + memantine or WBRT + memantine. The primary endpoint was time to cognitive function failure, defined as decline using the reliable change index on the Hopkins Verbal Learning Test-Revised (HVLT-R), Controlled Oral Word Association, or the Trail Making Tests (TMT) A and B. Patient-reported symptom burden was assessed using the MD Anderson Symptom Inventory with Brain Tumor Module and EQ-5D-5L.
Between July 2015 and March 2018, 518 patients were randomized. The median follow-up for living patients was 12.1 months. The addition of HA to WBRT + memantine prevented cognitive failure (adjusted hazard ratio, 0.74, P = .016) and was associated with less deterioration in TMT-B at 4 months (P = .012) and HVLT-R recognition at 4 (P = .055) and 6 months (P = .011). Longitudinal modeling of imputed data showed better preservation of all HVLT-R domains (P < .005). Patients who received HA-WBRT + Memantine reported less symptom burden at 6 (P < .001 using imputed data) and 12 months (P = .026 using complete-case data; P < .001 using imputed data), less symptom interference at 6 (P = .003 using complete-case data; P = .0016 using imputed data) and 12 months (P = .0027 using complete-case data; P = .0014 using imputed data), and fewer cognitive symptoms over time (P = .043 using imputed data). Treatment arms did not differ significantly in overall survival, intracranial progression-free survival, or toxicity.
With median follow-up exceeding 1 year, HA during WBRT + memantine for brain metastases leads to sustained preservation of cognitive function and continued prevention of patient-reported neurologic symptoms, symptom interference, and cognitive symptoms with no difference in survival or toxicity.
Complex dielectric spectra of the binary mixture of benzonitrile (BNZ) with acetophenone (ACPH) have been carried out at 11 different concentrations in the frequency range of 10 MHz to 40 GHz at four ...different temperatures (10°C, 15°C, 20°C and 25°C) using Time Domain Reflectometry technique. Static dielectric constant (ε
0
), relaxation time (τ) are obtained for above mentioned temperatures using nonlinear least squares fit method and density and refractive index are obtained at room temperature (25°C). These parameters are used to calculate the excess static dielectric constant (ε
0
E
) and excess inverse relaxation time (1/τ)
E
, excess molar volume (V
m
E
), effective Kirkwood correlation factor (g
eff
), Bruggeman factor (f
B
) and thermodynamic parameters such as enthalpy and entropy of activation of BNZ-ACPH mixture. Static dielectric constant decreases with increasing temperature and increasing concentration of ACPH in BNZ. The deviance in the excess parameters shows the strength of the molecular interactions and the presence of intermolecular interaction between unlike molecules. The measurement of Kerr constant (B) of the binary mixture of BNZ-ACPH have been reported for the wavelengths 632.8 nm and 512 nm for 5 different concentrations at room temperature using Electro-Optic Kerr Effect method. The change in the Kerr constant was observed for the different concentrations associated with the pure liquids. This deviation shows the non-additive behaviour and which is in good agreement with the dielectric parameters of the system under study. Also, the FTIR spectra have been obtained of BNZ-ACPH mixture to have a good agreement with the dielectric study.
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